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医学生如何增加价值?确定提升本科医学教育对患者护理和卫生系统价值的角色、障碍及策略。

How Can Medical Students Add Value? Identifying Roles, Barriers, and Strategies to Advance the Value of Undergraduate Medical Education to Patient Care and the Health System.

作者信息

Gonzalo Jed D, Dekhtyar Michael, Hawkins Richard E, Wolpaw Daniel R

机构信息

J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania. M. Dekhtyar is research associate, Medical Education Outcomes, American Medical Association, Chicago, Illinois. R.E. Hawkins is vice president, Medical Education Outcomes, American Medical Association, Chicago, Illinois. D.R. Wolpaw is professor of medicine and humanities, Penn State College of Medicine, Hershey, Pennsylvania.

出版信息

Acad Med. 2017 Sep;92(9):1294-1301. doi: 10.1097/ACM.0000000000001662.

Abstract

PURPOSE

As health systems evolve, the education community is seeking to reimagine student roles that combine learning with meaningful contributions to patient care. The authors sought to identify potential stakeholders regarding the value of student work, and roles and tasks students could perform to add value to the health system, including key barriers and associated strategies to promote value-added roles in undergraduate medical education.

METHOD

In 2016, 32 U.S. medical schools in the American Medical Association's (AMA's) Accelerating Change in Education Consortium met for a two-day national meeting to explore value-added medical education; 121 educators, systems leaders, clinical mentors, AMA staff leadership and advisory board members, and medical students were included. A thematic qualitative analysis of workshop discussions and written responses was performed, which extracted key themes.

RESULTS

In current clinical roles, students can enhance value by performing detailed patient histories to identify social determinants of health and care barriers, providing evidence-based medicine contributions at the point-of-care, and undertaking health system research projects. Novel value-added roles include students serving as patient navigators/health coaches, care transition facilitators, population health managers, and quality improvement team extenders. Six priority areas for advancing value-added roles are student engagement, skills, and assessments; balance of service versus learning; resources, logistics, and supervision; productivity/billing pressures; current health systems design and culture; and faculty factors.

CONCLUSIONS

These findings provide a starting point for collaborative work to positively impact clinical care and medical education through the enhanced integration of value-added medical student roles into care delivery systems.

摘要

目的

随着卫生系统的发展,教育界正在寻求重新构想学生角色,将学习与对患者护理的有意义贡献相结合。作者试图确定与学生工作价值、学生可为卫生系统增加价值的角色和任务相关的潜在利益相关者,包括在本科医学教育中促进增值角色的关键障碍和相关策略。

方法

2016年,美国医学协会(AMA)教育加速变革联盟中的32所美国医学院校召开了为期两天的全国会议,探讨增值医学教育;参会人员包括121名教育工作者、系统领导者、临床导师、AMA工作人员领导和顾问委员会成员以及医学生。对研讨会讨论和书面回复进行了主题定性分析,提取了关键主题。

结果

在当前的临床角色中,学生可以通过进行详细的患者病史询问以识别健康和护理障碍的社会决定因素、在护理点提供循证医学贡献以及开展卫生系统研究项目来提高价值。新的增值角色包括学生担任患者导航员/健康教练、护理过渡促进者、人群健康管理者和质量改进团队扩展人员。推进增值角色的六个优先领域是学生参与、技能和评估;服务与学习的平衡;资源、后勤和监督;生产力/计费压力;当前的卫生系统设计和文化;以及教师因素。

结论

这些发现为合作工作提供了一个起点,通过将增值医学生角色更好地融入护理提供系统,对临床护理和医学教育产生积极影响。

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